Contemporary Neurosurgical Approaches to Neurocysticercosis

Leonardo Rangel-Castilla Divisions of Neurosurgery and Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Infectious Diseases Section, Department of Medicine, Department of Neurosurgery, Department of Pathology, and Department of Radiology, Baylor College of Medicine, Houston, Texas

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Jose A. Serpa Divisions of Neurosurgery and Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Infectious Diseases Section, Department of Medicine, Department of Neurosurgery, Department of Pathology, and Department of Radiology, Baylor College of Medicine, Houston, Texas

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Shankar P. Gopinath Divisions of Neurosurgery and Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Infectious Diseases Section, Department of Medicine, Department of Neurosurgery, Department of Pathology, and Department of Radiology, Baylor College of Medicine, Houston, Texas

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Edward A. Graviss Divisions of Neurosurgery and Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Infectious Diseases Section, Department of Medicine, Department of Neurosurgery, Department of Pathology, and Department of Radiology, Baylor College of Medicine, Houston, Texas

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Pedro Diaz-Marchan Divisions of Neurosurgery and Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Infectious Diseases Section, Department of Medicine, Department of Neurosurgery, Department of Pathology, and Department of Radiology, Baylor College of Medicine, Houston, Texas

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A. Clinton White Jr Divisions of Neurosurgery and Infectious Diseases, University of Texas Medical Branch, Galveston, Texas; Infectious Diseases Section, Department of Medicine, Department of Neurosurgery, Department of Pathology, and Department of Radiology, Baylor College of Medicine, Houston, Texas

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Neurocysticercosis (NCC) includes a wide spectrum of illnesses. Newer neurosurgical approaches are being applied to NCC. Although clinical trials are leading to a consensus on medical management, fewer data address neurosurgical approaches. We reviewed all neurocysticercosis patients evaluated by neurosurgery at Ben Taub General Hospital, Houston, Texas, between August 1997 and December 2005. From 31 patients that had a neurosurgical evaluation, 16 patients were treated with shunts (5 had shunt failure requiring revision), 13 by surgical resection of cysts (9 underwent craniotomy and 4 endoscopy), and 2 by medical therapy. A fifth endoscopy was performed in one patient with shunt failure. None of the endoscopic patients needed another intervention. Despite the availability of anti-parasitic and anti-inflammatory therapies, neurosurgery continues to play an important role in the management of selected cases of NCC. In contrast to the high rate of shunt failure, neuroendoscopy seems to be associated with higher success rate than any other neurosurgical approach.

Author Notes

Reprint requests: A. Clinton White Jr, Department of Infectious Diseases, University of Texas Medical Branch (UTMB) 301 University Blvd., Galveston, TX 77555-0517, E-mail: acwhite@utmb.edu.
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